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Complications & miscarriage

Miscarriage Symptoms & Signs: How Can You Tell?

The early days of pregnancy can be as anxiety-provoking as they are exciting. How do you know if it’s going to stick? Are there miscarriage symptoms and signs you should be looking for?

What are signs of miscarriage?

Women who experience bleeding, spotting, brown discharge, cramping, or loss of pregnancy symptoms often fear the worst, but none of these are conclusive signs of miscarriages. Many women with these symptoms go on to have perfectly healthy, full-term pregnancies, and some women without any of these symptoms end up miscarrying.

By the same token, some women experience no signs of miscarriage at all, and don’t find out they’ve lost the pregnancy until their next doctor’s appointment. This is called a missed miscarriage. It only occurs in about one percent of all pregnancies.

The first thing to know is that while miscarriage and chemical pregnancy are common—up to 25 percent of pregnancies end in miscarriage—when you get that first positive pregnancy test, the far more likely outcome is not having a miscarriage. (If you need a little reassurance, check out this miscarriage odds calculator.)

No Morning Sickness

It’s true that nausea often signals a healthy pregnancy: women with nausea have only about one-third of the miscarriage risk as women with no nausea[1.http://www.ncbi.nlm.nih.gov/pubmed/2611170]. However, a lack of nausea does not necessarily signal an impending miscarriage. Somewhere between 20 – 30 percent of women manage to avoid morning sickness entirely, and still deliver perfectly healthy babies.

Pregnancy viability isn’t the only factor that determines whether you will experience morning sickness; demographic data also plays a role. White women are more prone to nausea than black or Asian women[2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2713199/], and black women are more likely to experience nausea only in the third trimester. Nausea also tends to be worse with each subsequent pregnancy.

Timing also matters: a lack of morning sickness before seven weeks does not predict miscarriage risk. It is only in the eighth week of pregnancy that a lack of nausea predicts a higher chance of miscarriage[3.https://www.ncbi.nlm.nih.gov/pubmed/2611170]. It doesn’t seem to matter when nausea begins or ends, as long as it has begun by the eighth week.

After the first trimester, nausea no longer has any bearing on miscarriage risk. If you’re one of the lucky few who experiences no morning sickness at all, by the time you make it to the second trimester, your odds of miscarriage are the same as anyone else’s (less than one percent[4.http://www.aafp.org/afp/2007/1101/p1341.html#afp20071101p1341-b1]).

It’s also important to note that morning sickness is poorly understood—no one really knows whether it serves a purpose, or is just an unpleasant side effect of increased hormone levels during pregnancy. Although it’s clear that healthy pregnancies more often have morning sickness than not, few researchers believe that a lack of nausea actually causes miscarriage. Why not? Well, for one thing, pregnant women who take anti-nausea medication do not have worse outcomes than those who don’t.

The bottom line: women who have no morning sickness have a higher miscarriage rate, but lack of morning sickness does not mean that you will miscarry.

Fading Symptoms of Pregnancy

What if you had symptoms such as nausea, exhaustion, and sore breasts, but then they disappeared? Does this mean that you are at greater risk of miscarriage?

The fact of the matter is, there is so much variability in intensity and duration of pregnancy symptoms that a change in symptoms should not be considered a sign of miscarriage. It’s true that some women who have miscarriages notice a sudden reduction in pregnancy symptoms or simply no longer “feel” pregnant. It’s also true that many women notice that their pregnancy symptoms disappear and yet nothing is wrong, and that other women experience strong, consistent pregnancy symptoms and yet still have miscarriages.

It’s common for pregnancy symptoms to fade towards the end of the first trimester, but for many women they may fade earlier, or come and go. You needn’t feel sick, bloated, and tired every single day to have a healthy pregnancy. If you notice that your pregnancy symptoms aren’t as strong as they were, consider yourself lucky and try to enjoy it!

The bottom line: try not to read too much into the day to day changes of your pregnancy symptoms. It’s normal for symptoms to fluctuate widely during the first trimester.

Bleeding or Spotting

Spotting during pregnancy can be terrifying, but it does not necessarily mean that you are having a miscarriage, even if the bleeding is heavy or you are passing clots. In fact, spotting during pregnancy is fairly common, and usually benign. There is no way to diagnose the cause of the spotting without further testing, so it’s important to let your healthcare provider know.

Aside from miscarriage, bleeding or spotting during pregnancy can be caused by irritation to the cervix, infection, or something called subchorionic hematoma. Sometimes, there is no known cause for the spotting, but if everything looks fine on an ultrasound it is usually a sign that your baby is fine.

The bottom line: spotting or bleeding during pregnancy can be scary, but it doesn’t necessarily mean you are having a miscarriage.

Cramping

Most women experience at least mild cramping during early pregnancy. It can be caused by a variety of factors. As your uterus expands during the first trimester, you may feel strange abdominal sensations or period-like cramping.

Gas pain is another common cause of early pregnancy cramping. High progesterone levels slow down digestion and can make it harder for you to digest large meals. Even though it’s just gas, it can be surprisingly intense and painful!

The bottom line: while cramping alone is not usually a sign of miscarriage, if you experience cramping along with bleeding, it’s a good idea to call your doctor.

Pregnancy Tests Not Getting Darker

Pregnancy tests look for the presence of a hormone called hCG. During the early weeks of pregnancy, hCG levels rise very rapidly: in most viable pregnancies, hCG levels should double roughly every 48 hours. Slow rising hCG levels can be a sign of miscarriage or ectopic pregnancy.

If you take a pregnancy test a few days before your missed period, you may notice that the second line is rather light. As your hCG levels rise, the second line on any subsequent tests you take should eventually get darker. If the second test line never darkens or starts to get lighter, it can sometimes be a sign of a chemical pregnancy.

But pregnancy tests that aren’t getting darker doesn’t necessarily mean that your pregnancy is doomed. Pregnancy tests are not as precise a measure of hCG as blood tests, and different test varieties and the saturation of your urine can both have an impact on the level of hCG detected.

It’s also important to note that after about seven weeks of pregnancy (three weeks after your missed period), pregnancy tests are no longer reliable due to something called the hook effect. At that point, hCG concentration is comprised mostly of a variant form of hCG that home pregnancy tests are not designed to detect. This can cause pregnancy tests taken after the first few weeks of pregnancy to be lighter or even negative. To test whether you are experiencing the hook effect, dilute your urine with water and take the test again—it should be darker.

The bottom line: pregnancy tests that aren’t getting darker can be a sign of a chemical pregnancy, but there are other explanations for this as well.

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